Arief Ariyanto, Usman Muhammad Andry, Sakti Muhammad, Lubis Andri Maruli Tua, Bukhari Agussalim
Medical and Health Science Faculty of State Islamic Alauddin University Makassar, Indonesia; Department of Orthopedic and Traumatology, Hasri Ainun Habibie Hospital Parepare, Indonesia.
Medical Faculty of Hasanuddin University Makassar, Indonesia.
Int J Surg Case Rep. 2022 Jun;95:107177. doi: 10.1016/j.ijscr.2022.107177. Epub 2022 May 10.
Osteoarthritis is a severe joint disease that affects more than 60% of the elderly and more common an idiopathic disease or unknown cause although there is also a secondary cause such as trauma, infection, neurological or metabolic disorders. The usual complaints that perceived by osteoarthritis patients is pain in the affected joint. Many patients and providers think of arthroplasty as the only surgical option for the treatment of osteoarthritis of the knee. However, there are several other surgical options for osteoarthritis which can be therapeutic alternatives. The role of bone marrow stimulation and intraarticular injection with triamcinolone and Hyaluronic acid combination on grade III knee osteoarthritis patient has not been reported.
Three patients who presented to orthopedic department with complaints of bilateral knee pain were identified with grade III osteoarthritis (Kellgren and Lawrence) receiving some kind of analgetic treatment for more than 1 year which provided pain relief for some time but not permanent. They underwent arthroscopic procedure (bone marrow stimulation) and then injected with triamcinolone and hyaluronic acid combination. Pre and post operation outcome scores (WOMAC score, Interleukin 15 and MRI) were assessed. At six-month follow-up, all patients reported improvement in pain and stiffness. WOMAC score and Interleukin 15 serum level decreases, MRI with Amadeus score showed improvement of cartilage defect.
This case report showed that our three patients were successfully treated with bone marrow stimulation and intraarticular injection with triamcinolone and hyaluronic acid combination. All three patients have improved in their functional outcome, IL 15 and cartilage defect.
Bone marrow stimulation and intraarticular injection with triamcinolone and hyaluronic acid combination can be a valuable treatment option for moderate active patients with grade III knee osteoarthritis.
骨关节炎是一种严重的关节疾病，影响着超过60%的老年人，它多为特发性疾病或病因不明，不过也有诸如创伤、感染、神经或代谢紊乱等继发性病因。骨关节炎患者通常感觉到的主诉是患关节疼痛。许多患者和医疗服务提供者认为关节置换术是治疗膝关节骨关节炎的唯一手术选择。然而，对于骨关节炎还有其他几种手术选择，它们可以作为治疗替代方案。骨髓刺激以及曲安奈德和透明质酸联合关节内注射对III级膝关节骨关节炎患者的作用尚未见报道。
三名因双侧膝关节疼痛就诊于骨科的患者被诊断为III级骨关节炎（凯尔格伦和劳伦斯分级），接受某种镇痛治疗超过1年，这种治疗能在一段时间内缓解疼痛，但并非永久性缓解。他们接受了关节镜手术（骨髓刺激），然后注射曲安奈德和透明质酸联合制剂。评估了手术前后的结果评分（WOMAC评分、白细胞介素15和磁共振成像）。在六个月的随访中，所有患者均报告疼痛和僵硬有所改善。WOMAC评分和白细胞介素15血清水平下降，采用阿马德乌斯评分的磁共振成像显示软骨缺损有所改善。
本病例报告表明，我们的三名患者通过骨髓刺激以及曲安奈德和透明质酸联合关节内注射得到了成功治疗。所有三名患者在功能结果、白细胞介素15和软骨缺损方面均有改善。
骨髓刺激以及曲安奈德和透明质酸联合关节内注射对于中度活动的III级膝关节骨关节炎患者可能是一种有价值的治疗选择。
